POVERTY REDUCTION PROGRAMMES AND CHILD HEALTH IN INDIA: WHAT IS

ACHIEVED AND WHAT CAN BE ACHIEVED

Brief history of poverty alleviation programmes (PAP) in India

Several poverty alleviation programmes in India meant to address poverty alleviation directly or
indirectly have been launched by the Government of India such as the Pradhan Mantri Jan Dhan
Yojana (PMJDY) – a financial inclusion scheme, the Pradhan Mantri Gramin– a housing scheme for
the rural poor, the Atal Pension Yojana (APY) – aimed at increasing pension scheme beneficiaries in
India, the Adarsh Gram Yojana (SAGY) – aimed at fostering infrastructure development in rural areas,
the Pradhan Mantri Fasal Bima Yojana (PMFBY) – a crop insurance scheme, the Pradhan Mantri
Krishi Sinchai Yojana – aimed at attracting irrigation investments, Deen Dayal Upadhyaya Grameen
Kaushalya Yojana (DDUGKY) – for skill development of rural youth, National Food Security Act
(NFSA)-for nutritional security.

Many of these schemes are quite nascent and performance evaluations of these schemes are rather
difficult. In the decades shortly after the turn of the century, the Mahatma Gandhi National Rural
Employment Guarantee Act (MNREGA) and the Public Distribution System (PDS) are prominent
examples of the running policies for poverty alleviation in rural India. Before the MGNREGA and the
PDS working under new legislation, the Integrated Rural Development Program (IRDP), the Mid-Day
Meal Scheme (MDMS), the National Family Benefit Scheme (NFBS) and the National Old Age Pension
Scheme (NOAPS) represent some of the older schemes aimed at benefitting poor people in rural
India.

An example in terms of an older government scheme for the benefit of rural India is the Integrated
Rural Development Programme (IRDP). The policy came into force in 1979 and aimed to help micro-
enterprises by extending loans to beneficiaries for the purchase of assets and by subsidizing asset
costs by between 25 and 50 per cent.

Health programmes like NHM, ICDS etc result in poverty reduction as health of the community
especially women and children will improve. With better human capital, more able they will be to
get skilled and work, thereby removing poverty.

PAPs and Child health

PAP (not targeting children per se) How it affect child health
PMJDY More money in hands of the woman – will focus on child
health
National Housing Scheme Better living conditions for family = better health for the
child
MGNREGA, IRDP, Skill India, Start Up More household income = money for child health
India, MUDRA
PMFBY Less debt = more money with family to focus on child
NFSA, PDS Food for child and mothers = more health for child
MDMS Food for child = health
NHM Health of family = health for child
Gram Sadak Yojana Connectivity to health centres
PAPs that target children, focussing on child health

Under National Health Mission (NHM) the provision of health care to children particularly in rural
areas is given priority attention. Janani Shishu Suraksha Karyakaram (JSSK) under NHM, entitles all
pregnant women delivering in public health institutions to absolutely free and no expense delivery
including Caesarean section. The initiative stipulates free drugs, diagnostics, blood and diet, besides
free transport from home to institution, between facilities in case of a referral and drop back home.
Similar entitlements have been put in place for all sick infants accessing public health institutions for
treatment till one year of age.

Universal Immunization Programme (UIP) covers about 13.5 crore children for vaccination against
seven vaccine preventable diseases, through 90 lakh immunization sessions each year. Mission
Indradhanush seeks to achieve 90% full immunization coverage of India by year 2020. The objective
is to ensure high coverage of children with all vaccines in the entire country with a high focus on the
201 identified districts. Intensive planning and monitoring of these campaigns covering all children
up to two years of age and pregnant women for tetanus toxoid vaccine is done.

To sharpen the focus on vulnerable and marginalized populations in underserved areas, 184 High
Priority Districts have been identified across the country for accelerating implementation of
Reproductive Maternal Newborn Child Health+ Adolescent (RMNCH+A) interventions for achieving
improved maternal and child health outcomes.

National Guidelines on Infants and Young Child Feeding emphasize the importance of breast feeding.
The Integrated Child Development Services Scheme aims at providing services to pre-school children
in an integrated manner so as to ensure proper growth and development of children in rural, tribal
and slum areas.

Poshan Abhiyan, the recently launched nutrition mission, aims to improve the nutritional status of
children in that age range, adolescent girls, pregnant and lactating women. Rashtriya Bal Swasthya
Karyakram to provide comprehensive care to all the children in the age group of 0–18 y in the
community (with a 4D thrust to screen for and manage birth Defects, Diseases, Deficiencies and
Developmental delays, including disabilities). India Newborn Action Plan to reduce neonatal
mortality and stillbirths. Mother and Child Tracking System to ensure registration and tracking of all
pregnant women and newborn babies so that provision of regular and complete services to them
can be ensured. The impact of these concerted efforts was clearly visible on the under 5 mortality
rate which came down from 111 per 1000 live births in 1990 to 39 in 2018.
What remains to be done

Achieving targets under NHP and SDG is what remains to be done.

Child Health goals under National Health Policy 2017/SDG: The Child Health programme under the
Reproductive, Maternal, Newborn, Child and Adolescent (RMNCH+A) Strategy of the National Health
Mission (NHM) comprehensively integrates interventions that improve child health and nutrition
status and addresses factors contributing to neonatal, infant, under-five mortality and malnutrition.
The National Population Policy (NPP) 2000, the National Health Policy 2002, Twelfth Five Year Plan
(2007-12), National Health Mission (NRHM - 2005 – 2017), Sustainable Development Goals (2016-
2030) and New National Health Policy, 2017 have laid down the goals for child health.

Child Health Goals under SDG: Goal 3.2: By 2030, end preventable deaths of newborn and children
under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12
per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births.
How to do it?

Health as a right should be the focus and grassroot level institutions like Gram Sabhas along with the
help of NGOs should implement government schemes on a war footing. ASHAs and ANWs has an
important role to play in this regard. Adequate health literacy to families especially women and
creation of health infrastructure by the Government should be focussed on.

Embracing development assistance, particularly when it comes to the provision of vaccines; pursuing
the empowerment of women and girls and addressing inequities in healthcare and development;
and moving towards universal health coverage (UHC) are all suggested as means of making child
health better and ensuring each young person can live a life where their full potential is realised and
their security and welfare is ensured.

While the thrust to eliminate undernutrition is essential, the rising threat of overweight and obesity
among children and adolescents needs to be addressed through programmes promoting healthy
nutrition and physical activity. Otherwise, the danger of early onset of non-communicable diseases
looms large. A life course approach to health and nutrition must become a feature of our policy and
programme response to the health transition that is underway.

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